连续肾脏替代疗法联合常规方案治疗脓毒症的效果分析

摘要

Objective To investigate the clinical effect of continuous renal replacement therapy( CRRT)combined with conventional therapy on sepsis. Methods A total of 53 patients with sepsis who received treatment in the Intensive Care Unit of Taizhou People's Hospital from June 2011 to October 2013 were enrolled and were divided into observation group(n = 27) and control group(n = 26). The control group was treated with conventional therapy and the observation group received CRRT combined with conventional therapy. Indicators reflecting infection condition were recorded before and 7 days after treatment, including WBC,PCT,CRP,TNF - α,IL - 1β,IL - 6 and IL - 10. Indicators reflecting haemodynamics and tissue perfusion were also recorded,including heart rate and the level of blood lactic acid. Clinical outcomes included length of hospital stay, hospitalization cost,APACHE Ⅱ score on day 7 after treatment and mortality. Results Before treatment,there were no significant differences between the two groups in WBC,PCT,CRP,TNF - α,IL - 1β,IL - 6 and IL - 10(P > 0. 05). On day 7 after treatment,the two groups were significantly different(P < 0. 05)in WBC,PCT,CRP,IL - 1β,IL - 6 and were not significantly different(P > 0. 05)in TNF - α and IL - 10. On day 7 after treatment,the heart rate of the observation group was(80. 3 ± 7. 2) times/ min,lower than that of control group which was(95. 3 ± 7. 8) timnes/ min,with the difference significant(t = 7. 267,P < 0. 05). On day 7 after treatment,the level of blood lactic acid was(1. 05 ± 0. 36)mmol/ L,lower than that of control group which was(1. 51 ± 0. 34)mmol/ L,with the difference significant(t = 4. 784,P < 0. 05). The two groups were significantly different in length of hospital stay and APACHE Ⅱ score(P < 0. 05),and no significantly different in hospitalization cost and mortality( P > 0. 05). Conclusion CRRT combined with conventional therapy has better effects on patients with sepsis in alleviating infection,controlling inflammatory response,maintaining hemodynamic stability,improving tissue perfusion and reducing the length of hospital stay.%目的：探讨连续肾脏替代疗法（CRRT）联合常规方案治疗脓毒症的临床效果。方法选取2011年6月—2013年10月于泰州市人民医院重症监护室治疗的53例脓毒症患者为研究对象，根据是否采用 CRRT 分为观察组（27例）和对照组（26例）。对照组患者进行常规治疗，观察组患者在常规治疗基础上联合应用 CRRT。以治疗前和治疗后7 d 白细胞计数（WBC）、降钙素原（PCT）、C 反应蛋白（CRP）、肿瘤坏死因子α（TNF -α）、白介素（IL）-1β、IL -6、IL -10反映感染情况，以心率和血乳酸水平反映血流动力学及组织灌注情况，以住院时间、住院费用、治疗后7 d 急性生理与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分及病死率反映临床结局。结果两组治疗前 WBC、PCT、CRP、TNF -α、IL -1β、IL -6、IL -10水平比较，差异无统计学意义（P ＞0.05）。两组治疗后7 d WBC、PCT、CRP、IL -1β、IL -6水平比较，差异有统计学意义（P ＜0.05）。两组治疗后7 d TNF -α、IL -10水平比较，差异无统计学意义（P ＞0.05）。观察组治疗后7 d 心率为（80.3±7.2）次/ min，低于对照组的（95.3±7.8）次/ min，差异有统计学意义（t ＝7.267，P ＜0.05）；观察组治疗后7 d 血乳酸水平（1.05±0.36） mmol/ L，低于对照组（1.51±0.34）mmol/ L，差异有统计学意义（t ＝4.784，P ＜0.05）。两组住院时间、APACHE Ⅱ评分比较，差异有统计学意义（P ＜0.05）。两组住院费用、病死率比较，差异无统计学意义（P ＞0.05）。结论 CRRT 联合常规治疗能改善脓毒症患者的感染状况，控制机体炎性反应，维持血流动力学稳定，改善组织灌注，缩短住院时间。